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HomeMy WebLinkAboutFlowers & Associates - 2016 Agreement - Amendment No. 2AMENDMENT TO THE AGREEMENT FOR SERVICES BETWEEN CITY OF GILROY AND FLOWER AND ASSOCIATES INC. FOR MICRO - SURFACING PROJECT DESIGN DATED MAY 27, 2016 P.O. 161012 AMENDMENT NO.2 This Amendment shall become effective when it has been signed by the City Administrator, Project Manager, and Consultant. All copies forwarded to Consultant for signature shall be returned to the City of Gilroy properly filled out. Upon acceptance by the City, the Consultant's copy will be returned to him as his authority to proceed with the work. Amend existing contract for Flowers & Associates Inc. for an amount of $34,144 to expand the scope of work to include ADA curb ramps, sidewalk repairs, new types of pavement treatment such as asphalt overlay, cape seal, in addition to microsurfacing. These new changes will increase engineering design hours and will increase the number of working days needed to finish the construction job. All requirements of the original Agreement Documents shall apply to the above work except as specifically modified by this Amendment. The contract time shall not extend unless expressly provided for in this Amendment. Flowers & Associates Inc. hereby agrees to perform the above work subject to the terms of this Amendment for design and construction management of street improvements throughout City of Gilroy. Consultant: Flowers & Associates Inc. sy Robert T. Fl wers, P.E. Date ACCEPTED: 1 } roject M Z We Date �,_-,r Department Head bate 111, /i-7 City Administrator Date W.O. 1623 X1 October 23, 2016 Mr. David Stubehaer, P.E. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 -197 Subject: Request for Extra Services — Phase 1 Pavement Maintenance Project Dear David: Pursuant to our conversation this letter is to request additional design services for the City of Gilroy Phase 1 Pavement Maintenance Project, Agreement No. 161206. Based on conversations and direction by the City, Phase 1 Proposal was based on crack seal, micro surfacing and striping with a construction budget of $500,000, resulting in an estimated twenty two (22) working day Contract Period. During the design process, the City directed our office to increase the size and scope of the Project, increasing the maintenance types included in the Project. Subsequently this resulted in a Project with a construction budget of $1,310,000 and a forty five (45) working day contract period. This increase resulted in more effort on the design and will result in additional effort in construction observation and materials testing for the construction phase of the. work. We are respectfully requesting extra services (Agreement No. 161206) in the amount of $34,200 to cover the anticipated additional costs. We appreciate your continued consideration of our firm. Sincerely, FLOWERS & SSOCIAT , INC. By: ian H. Chi nci Associate Engineer 1623_ExtraServicesPhs 1_20161023.doc By: obert T. FI wers President R.C.E.18,324 FLOWERS & As SOCIATES. INC. larhierici _lteOrl l"n v � '1;bHers C I U ! t 14 v I N E E R S Robert. A. Schmidt <Cr )b 192 Vgr, nr � ;Ifi i, � 2: `OR-'� A. __ „ESAR „ CHA.VE-2. SUIT= ,,30, 3Ai\474, 0 ,'C" '3:15 Gelara vlaccn ice sss?o PHONE 805,966,2224 , SAX: 305.961.3372 wuvw. lowersassoc.corn W.O. 1623 X1 October 23, 2016 Mr. David Stubehaer, P.E. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 -197 Subject: Request for Extra Services — Phase 1 Pavement Maintenance Project Dear David: Pursuant to our conversation this letter is to request additional design services for the City of Gilroy Phase 1 Pavement Maintenance Project, Agreement No. 161206. Based on conversations and direction by the City, Phase 1 Proposal was based on crack seal, micro surfacing and striping with a construction budget of $500,000, resulting in an estimated twenty two (22) working day Contract Period. During the design process, the City directed our office to increase the size and scope of the Project, increasing the maintenance types included in the Project. Subsequently this resulted in a Project with a construction budget of $1,310,000 and a forty five (45) working day contract period. This increase resulted in more effort on the design and will result in additional effort in construction observation and materials testing for the construction phase of the. work. We are respectfully requesting extra services (Agreement No. 161206) in the amount of $34,200 to cover the anticipated additional costs. We appreciate your continued consideration of our firm. Sincerely, FLOWERS & SSOCIAT , INC. By: ian H. Chi nci Associate Engineer 1623_ExtraServicesPhs 1_20161023.doc By: obert T. FI wers President R.C.E.18,324 FLOWERS & AS SOCIATES. INC. C i y I L � i G I M = _ 2 3 ,714�::'C+ _ vMV" .•I- .� Ir 1•.i', .)i';': .:._ � :l is KUti Iri �': .i.. W.O. 1623 10/23/16 Estimated Staff loading for Design Engineering Services for City of Gilroy 2016 Pavement Maintenance Project PRIN ASSOC SR ENG DESIGN DRAFT W/P TOTAL TASK ENGR/SR INPECTOR STREETS SURVEY 1. Field review streets selected by the City 2, list of streets S recommended repair method 3. Attend 2 Meetings. CONTRACT DOCUMENTS - 2 SETS 1. Field review (2) 2. Opinion of cost at 30 %, 60% and 90% (2) 3. Attend 2 Meetings 4. Design/Mark Streets 5. Prepare Contract documents (2) 6. Recommend materials/performance testing BID ASSISTANCE 1. Assist City with bidding and addenda REVISED CONTRACT MANAGEMENT /OBSERVATION - Phase 1 (45 Days) CrackSeal/PavePrep/Conc Repairs/Grind AC/AC Overlay lRubberizedCapeSsaUMicro - Surface 1, Provide contract management for the project 0 8 8 2. Provide Observation services for the project 8 192 16 200 Staff By Category Totals 0 8 16 192 0 0 216 Billing Rate ($/hr) $185 $170 $152 $131 $105 $95 Total Personnel Cost ($) $0 $1,360 $2,432 $25,152 $0 $0 $28,944 Staffing Ratio (% of total hrs) 0.0 3.7 7.4 88.9 0.0 0.0 Average Personnel Cost ($ /hr) 134.00 Description of Other Project Costs Fugro Consultants $2,000 Cost of Consultant @10% $200 Traveling, Hotel & Subsistence $3,000 Repro/Misc. $0 Total of other costs ($) $5,200 Total Estimated Project Cost ($) $34,144 FLOWE -2 OP ID: JD .4COR15' 41t,� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY`r) 12/09/2016 THIS CERTIFICi4TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement (s). PRODUCER California Meridian Ins. 9700 El Camino Real Atascadero, CA 93422 House Account CONTACT NAME: tackle Deskin PHONN, Ell: 805- 466-3400 FAX No): 805 -466 -6148 E-MAIL S: jackie@californiameridian.com ADDRES-- INSURER (S) AFFORDING COVERAGE NAIC # INSURER n: California Automobile Ins. Co. 38342 $ INSURED Flowers & Associates, Inc.. INSURER B : National Union Fire Ins Co 19445 201 N. Cal le Cesar Chavez #100 MED EXP (Any one person) $ Santa Barbara, CA 93103 INSURER C PERSONAL & ADV INJURY $ I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7] PRO- JECT LOC OTHER: GENERAL AGGREGATE INSURER D: . PRODUCTS - COMP/OP AGG INSURER E $ INSURER F:: AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON OWNED AUTOS COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN POLICY NUMBER POLICY EFF MM1 C POLICY EXP MM/DD LIMITS Attn: David Stubchaer, P.E. 7351 Rosanna Street COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7' OCCUR Gilroy, CA 95020 !' EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7] PRO- JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON OWNED AUTOS X BA040000029127 09/01/2016 09/01/2017 COMBINED SINGLE LIMIT Ea accident $' 11000,000 _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE EBU060476793 09/01/2016 09/01/2017 EACH OCCURRENCE $ 5'5,000,00 X AGGREGATE $ 5,000,00 DED RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If.g, describe. under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE _ $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Gilroy, its officers, officials, and employees are additional insured per attached endorsement CA20480299. RE: W.O. 1445 FY-15 Slurry Seal Pavement Maintenance Design & Inspection Services 2015%2018 CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.. City of Gilroy AUTHORIZED REPRESENTATIVE J Attn: David Stubchaer, P.E. 7351 Rosanna Street House Account Gilroy, CA 95020 !' ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ,a►coRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) 1 8/25/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dealey, Renton & Associates 199 S. Los Robles Ave #540 Pasadena, CA 91101 CONTACT Marie Swaney PHONE FAX 626 -844 -3070 DDR . mswaney @dealeyrenton.com INSURERS AFFORDING COVERAGE NAIC # Lic #0020739 INSURERA:Hartford Ins. Co of Midwest 37478 9/1/2016 INSURED FLOWEASSO INSURER B :Travelers Property Casual Co of A 25674 Flowers & Associates, Inc. INSURER Nesco Insurance Co. 25011 201 North Calle Cesar Chavez, Suite 100 Santa Barbara, CA 93103 INSURER D 8055 -966 -2224 INSURER E X INSURER F: $10,000. _ COVERAGES CERTIFICATE NUMBER: 502788224 REVISION 'NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE, TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE O_FINSURANCE ADDL5U5R INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD __ -. __ LIMITS. B X COMMERCIAL GENERAL LIABILITY Y Y 6801H980764 9/1/2016 911/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR PREMISES DAMAGE TO RENTED PREMISES Ea occurrence $1:,000;000 X MED EXP (Any one person ) $10,000. _ Contractual Liab 2L XCU Included PERSONAL B ADV INJURY $1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X EC 7 LOC PRODUCTS - COMPIOP AGG $2,000,000 Ded $0 OTHER: AUTOMOBILE LIABILITY O accident) BIKE N I $ BODILY INJURY (Per person) $ ANY AUTO AUT OWNED SCHEDULED BODILY INJURY (Per accident) $ NON OWNED HIRED AUTOS AUTOS OP R DAMAGE Per accident $ UMBRELLA L1AB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE 11 DED RETENTION . $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Y 72WEGPI0126 9/1/2016 9/1/2017 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEIE $1,000,000 If yes, describe.under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 C Professional Liability i Contractor's Pollution Liab Retro Date: 10/1/1977 Y. ARA125588800 8/26/2016 8/26/2017 $2,000,000 per claim $4,000,000 Annual Aggregate $25,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Cancellation Notice: 30 day /10 day for non -pay or premium will be mailed to the certificate holder. AM Best's Rating on all policies above: A/XI I Or greater. RE: WO #1445, 2015/2016 Pavement Design /Construction — City of Gilroy, its officials, officers and employees are named as additional insured as respects general liability for claims arising from the operations of the named insured as required per written contract or agreement. SEE CANCELLATION SECTION of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. See Attached... GCtC111-II:AIt MULLJtK GANGtLLAI IUN ou LJay IVVId I Uay iur riunpdy ui prem City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 071988 -2014 ACORD CORPORATION_ All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACO AGENCY CUSTOMER ID: FLOWEASSO LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Dealey, Renton & Associates Flowers & Associates, Inc. 201 North Calle Cesar Chavez, Suite 100 Santa. Barbara, CA 93103 POLICY NUMBER 805 -966 -2224 CARRIER 7I_CCODEi EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ZO FORM TITLE: Coverage afforded the additional insured is primary and non - contributory as respects to general liability coverage. Insurance coverage includes waiver of _subrogation per the attached endorsement(s). SEE CANCELLATION SECTION of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. ACORD 101 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured: Flowers & Associates, Inc. Producer: Dealey, Renton & Associates Schedule Person or Organization City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 Additional Premium % We have the right to recover our payments from any- one liable for an injury- .covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) Authorized Representative WC040306 Policy Number 72WEGP10126 Effective Date 9/1/2016 Job Description City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction You rust maintain payroll records accurately segre- gating the remuneration of your employees while. en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. POLICY NUMBER: 6801H980764 COMMERICAL GENERAL LIABILITY ISSUE DATE: 8/25/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy, its officials, officers and employees Attn: David,Stubchaer 7351 Rosanna Street Gilroy CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction PROVISIONS A The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for bod- ily injury", 'property damage" or 'personal injury caused, in whole or in part, by your acts or'omis- sions or the acts or omissions of those acting on your behalf: In the performance of your ongoing oper- ations; In connection with premises owned by or rented to you; or C. In connection with your work and included within the "products - completed operations hazard." Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury' for which that person or organization has assumed liability in a contract or agreement. CG D3 82 09 07 The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services ". The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that 'contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a contract or agreement requiring insurance that, for the addi- tional insured shown n the Schedule, the insur- ance provided to that additional insured under this © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission Page 1 COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent . or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs,, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 Page 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission POLICY NUMBER: BA040000029127 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER, COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 9/01/16 Countersigned By:,�'I Named Insured: Flowers & Associates, Inc. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑